Pakistani farmer Mohammed Akram was about to dine with his family one October evening when an Indian mortar shell arced above his wheat field and slammed into his courtyard. Shrapnel hit his head, just above the ear, his left arm, and left hand.

"Our lives are hanging in the balance," said Mr. Akram, a 65-year-old who still hasn't fully recovered from his injuries. "Here on the border, this is the pattern since we were...